- With Mayo Clinic rheumatologist
April Chang-Miller, M.D.
read biographyclose windowBiography of
April Chang-Miller, M.D.
April Chang-Miller, M.D.
Dr. April Chang-Miller is board certified in internal medicine and rheumatology and is a consultant in the Division of Rheumatology at Mayo Clinic in Arizona.
Dr. Chang-Miller's primary field is rheumatology with special interests in inflammatory joint diseases called seronegative spondyloarthropathies, such as ankylosing spondylitis and psoriatic arthritis. She also cares for patients with rheumatoid arthritis and polymyalgia rheumatica.
The New York City native is a graduate of the Yale School of Medicine. Dr. Chang-Miller joined the Mayo Clinic staff in Rochester, Minn., in 1991, and in 2002 she relocated to Mayo Clinic in Arizona. She is a fellow in the American College of Rheumatology and has been on the board of directors of the Arthritis Foundation North Central Chapter.
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Question
Palindromic rheumatism: Does it cause joint pain?
I sometimes have joint pain caused by palindromic rheumatism. As I get older, are these attacks likely to damage my joints?
Answer
from April Chang-Miller, M.D.
Palindromic rheumatism is closely linked to rheumatoid arthritis, which damages joints by causing chronic inflammation. Right now, though, there's no reliable way to predict how quickly palindromic rheumatism will progress — or whether it will get worse at all.
Palindromic rheumatism causes sudden attacks of joint pain and swelling, typically in the hands and feet. An episode of palindromic rheumatism may last from just a few hours to several days.
The frequency of attacks also varies. Some people experience more than one episode a week, while others have only three or four a year. Between attacks, pain and swelling completely disappear, and the affected joints look normal on X-rays.
An unknown number of people with palindromic rheumatism go on to develop rheumatoid arthritis, but the progression may take several years. In one study, 40 out of 60 people newly diagnosed with palindromic rheumatism had chronic joint inflammation within 10 years. Progression to rheumatoid arthritis was less common in other studies with shorter follow-up periods.
Drugs originally designed to combat malaria are often helpful in reducing the frequency and duration of attacks. These drugs also appear to reduce the likelihood that palindromic rheumatism will progress to rheumatoid arthritis.
- Koskinen E, et al. Palindromic rheumatism: Longterm outcomes of 60 patients diagnosed in 1967-84. The Journal of Rheumatology. 2009;36:1873.
- Venables PJW, et al. Clinical features of rheumatoid arthritis. http://www.uptodate.com/home/index.html. Accessed May 10, 2011.
- Kaushik P. Palindromic rheumatism: A descriptive report of seven cases from North Dakota and a short review of literature. Clinical Rheumatology. 2010;29:83.
- Iyer VR. Palindromic rheumatism. Southern Medical Journal. 2011;104:147.
- Gonzalez-Lopez L, Gamez-Nava JI, Jhangri G, et al. Decreased progression to rheumatoid arthritis or other connective tissue diseases in patients with palindromic rheumatism treated with antimalarials. The Journal of Rheumatology. 2000;27:41.
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